alternative to surgery!

[natalie]

My mom was approved for this procedure! Now I have to fight the insurance company. I've only heard positive things about this! The article says that it doesn't consider cases over 3 cm, but my mom's tumor is 5cm x 3cm, so ignore that part! More info about this is in my other posting "RFA to the lungs"

Sacramento Bee/Manny Crisostomo

Some cancer patients now have a less painful alternative to surgery

By Alison C. Burggren -- Bee Staff Writer

Published 2:15 a.m. PDT Tuesday, July 29, 2003

A new but unproven medical procedure using radio waves to kill tumors is giving a small group of patients at Sutter Cancer Center in Sacramento an alternative to surgery.

Radiofrequency ablation is only appropriate for a limited number of patients and can have unwanted side effects. But for some lung, liver, bone and kidney cancer patients with no other options, the novel approach is a welcome one.

For Judy Callahan of Fair Oaks, it was an easy decision to try the procedure. A cancer patient since 1986, her six surgeries were so excruciating that the pain lasted for months afterward. So last year when doctors found tumors in both her lungs, they suggested the less painful alternative.

Callahan, 56, underwent the radiofrequency ablation, or RFA, to kill her lung tumors.

"I woke up from anesthesia and felt wonderful," she said. She walked out of the hospital that same day. The following day she had her nails done and attended a book club meeting -- pain-free.

But RFA is not for everyone.

Surgeon Gregory Graves and interventional radiologist Scott Foster said only 30 percent of patients considered for the procedure at Sutter Cancer Center actually get it. RFA is generally reserved for cases in which surgery is not an option.

Foster said the center has a multidisciplinary lung tumor board made up of five specialists who must all agree that RFA is the appropriate treatment in a particular case. But they hope that one day patients will get to choose RFA as an alternative to standard surgery.

RFA uses a needle inserted through the skin into the tumor to deliver electrical current, guided by computer tomography or magnetic resonance imaging to the correct place.

Doctors performing RFA insert the needle, push down on the end of it, and open a tiny umbrella of thin wires inside the tumor, allowing the current to be evenly dispersed. The current chars the diseased tissue, leaving the body to naturally absorb the dead cells and get rid of them as waste.

Some patients have bled internally and others have developed fevers after RFA. One patient at Sutter Cancer Center died from a blot clot that formed in a lung.

Tumors larger than 3 centimeters in diameter generally are not considered good candidates for RFA because of the risk in not removing all the tumor tissue. Graves said RFA is 95 percent effective at controlling tumors less than 3 centimeters but only 50 percent effective on tumors greater than 5 centimeters.

However, because RFA is a local treatment that is relatively well-tolerated compared to patient recovery from surgery, it can be repeated as often as needed to keep patients comfortable.

Graves said patients have traveled long distances to Sacramento for this procedure. Patients have come from as far away as London.

RFA is available at about a dozen sites across the country, Sutter spokeswoman Robin Montgomery said.

No large, randomized clinical trial has been done to look at long-term survival rates for RFA patients. Dr. Herman Kattlove, medical oncologist and editor for the American Cancer Society, said RFA can only be offered to patients as temporary relief from their tumor.

Clinical trials, Kattlove said, must show positive outcomes, an increase in survival rates and an increase in the quality of life for RFA to be classified as a treatment that can get rid of cancer.

"I'm a skeptic," said Kattlove.

Graves and Foster hope that a clinical trial expected to start soon at the Sutter Cancer Center will provide longevity statistics. These patients, Graves said, will be followed indefinitely to determine how effective RFA is at killing tumors.

The trial will be funded by Boston Scientific Corp., the manufacturer of tools used in the procedure. The study will look at patients with tumors at one site and patients with tumors that have spread to other areas, or metastatic tumors.

Graves and Foster said that 45 percent of their RFA cases are for lung cancer, 45 percent of them are for liver cancer, and the remaining 10 percent are for bone and kidney cancer.

More than 85 percent of liver cancer patients have complications that make traditional surgery impossible. Without treatment, most patients die within two years and only 2 percent make it five years.

Graves said the longest living recipient of the RFA procedure is 2 1/2 years out from treatment and doing well.

In Callahan's case, the two tumors treated last year have not reappeared, although doctors told her they found a new, tiny tumor they may treat with RFA at some point.

Graves expects it will take a decade of research to decide how well it works and to determine the procedure's success rate in allowing patients to live cancer-free.

"We think it's curative. It's just a matter of getting the numbers over time," Graves said of the results expected from the upcoming clinical trial.

Callahan doesn't need the numbers. "Absolutely, without a doubt, I would recommend (RFA) to someone else. It's taken a huge weight off my shoulders," she said.

--------------------------------------------------------------------------------

About the Writer

---------------------------

The Bee's Alison Burggren can be reached at (916) 321-1008 or aburggren@sacbee.com

[jgordo]

This is the first time I have read that article.

Much of the information there is incorrect. I had a 9 cm tumor abalated last December and so far, so good. The physician who did my ablation told me he has done up to 13 cm (about the size of a grapefruit) by multiple placements of the needle.

And I can't imagine what "unwanted side effect" they might be talking about.

My ablation It cost about 18,000 and surgery would have been 80,000+ including sugery and recovery. I walked out th day of the procedure

and went grocery shopping that night.

Insurance is a problem. Except for liver cancer they still consider RFA experimental so they can refuse to pay. But it make no sense for them to put the patient through torment, then pay 80,000 instead of 18,000.

RFA saved my life. Makes me angry to see thsi slant which might discourage others. Thanks for bringing to to my attention.